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Persistence of Primitive Reflexes in Developmental Disorders

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Abstract

Purpose of Review

Neonates present with a number of primitive reflexes that typically dissipate in later infancy. Persistence of such reflexes past infancy could indicate some type of developmental problem or compromised neurology and therefore might be predictably associated with various types of developmental disorders. The present review sought to summarize key studies investigating the persistence of primitive reflexes in individuals with cerebral palsy, attention-deficit/hyperactivity disorder, autism spectrum disorder, and other developmental disorders.

Recent Findings

Several studies have shown persistence of primitive reflexes in children with cerebral palsy, attention-deficit/hyperactivity disorder, and autism spectrum disorder. Persistence of primitive reflexes varies in relation to the type and severity of symptoms in cases of cerebral palsy and attention-deficit/hyperactivity disorder and with the presence of comorbid intellectual disability in children with autism spectrum disorder. Primitive reflexes have also been shown to persist in adults with Down syndrome.

Summary

Assessing primitive reflexes may be useful for advancing the understanding and early detection of developmental disorders. Additional research should seek to clarify the relation between the persistence of primitive reflexes and the type and severity of developmental disorders, as well as seeking to identify possible reflex phenotypes. Persistence of primitive reflexes might signal some type of developmental or neurological problem and may negatively impact motor development and learning. Evidence-based interventions to address the persistence of primitive reflexes are lacking, and the development of these should be a research priority.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mercuri E, Ricci D, Pane M, Baranello G. The neurological examination of the newborn baby. Early Hum Dev. 2005;81:947–56.

    PubMed  Google Scholar 

  2. Chandradasa M, Rathnayake L. Retained primitive reflexes in children, clinical implications and targeted home-based interventions. Nurs Child Young People. 2019;32:37–42.

    PubMed  Google Scholar 

  3. Futagi Y, Toribe Y, Suzuki Y. Neurological assessment of early infants. Curr Pediatr Rev. 2009;5:65–70.k.

    Google Scholar 

  4. Jakobi J, Kohn S, Kuzyk S, Fedorov A. When kicking the doctor is good: a simple reflex. Front Young Minds. 2017;5:10. https://doi.org/10.3389/frym.2017.00010.

    Article  Google Scholar 

  5. Hamer EG, Dijkstra LJ, Hooijsma SJ, Zijdewind I, Hadders-Algra M. Knee jerk responses in infants at high risk for cerebral palsy: an observational EMG study. Pediatr Res. 2016;80:363–70.

    PubMed  Google Scholar 

  6. Fetcho JR, McLean DL. Startle response. In: Squire LR, editor. Encyclopedia of neuroscience. Cambridge: Academic press; 2009. p. 375–9.

    Google Scholar 

  7. Valls-Sole J. Spontaneous, voluntary, and reflex blinking in clinical practice. J Clin Neurophysiol. 2019;36:415–21.

    PubMed  Google Scholar 

  8. Leder SB. Gag reflex and dysphagia. Head Neck. 1996;18:138–41.

    CAS  PubMed  Google Scholar 

  9. Boes CJ. The history of examination of reflexes. J Neurol. 2014;261:2264–74.

    PubMed  Google Scholar 

  10. Gieysztor EZ, Choinska AM, Paprocka-Borowicz M. Persistence of primitive reflexes and associated motor problems in healthy preschool children. Arch Med Sci. 2018;14:167–73.

    PubMed  Google Scholar 

  11. Grzywniak C. Role of early-childhood reflexes in the psychomotor development of a child, and in learning. Acta Neuropsychol. 2016;14:113–29.

    Google Scholar 

  12. Paulson G, Gottlieb G. Developmental reflexes: the reappearance of foetal and neonatal reflexes on aged patients. Brain. 1968;91:37–52.

    Google Scholar 

  13. Modrell AK, Tadi P. Primitive reflexes. In: StatPearls. Treasure Island: StatPearls Publishing; 2020. https://europepmc.org/article/med/32119493#impact. Accessed 11 Nov 2020.

  14. Rousseau PV, Matton F, Lecuyer R, Lahaye W. The Moro reaction: more than a reflex, a ritualized behavior of nonverbal communication. Infant Behav Dev. 2017;46:169–77.

    PubMed  Google Scholar 

  15. Chinello A, Di Gangi V, Valenza E. Persistent primary reflexes affect motor acts: potential implications for autism spectrum disorder. Res Dev Disabil. 2018;83:287–95.

    PubMed  Google Scholar 

  16. Jacobs L, Gossman MD. Three primitive reflexes in normal adults. Neurology. 1980;30:184–8.

    CAS  PubMed  Google Scholar 

  17. Gulati S, Sondhi V. Cerebral palsy: an overview. Indian J Pediatr. 2018;85:1006–16.

    PubMed  Google Scholar 

  18. Capute AJ. Identifying cerebral palsy in infancy through study of primitive-reflex profiles. Pediatr Ann. 1979;8:34–42 This pioneering study established the utility of a standardized protocol (primitive reflex profile) for assessing the persistence of primitive reflexes in children with cerebral palsy.

    Google Scholar 

  19. Capute AJ, Accardo PJ, Vining EPG, Rubenstein JE, Walcher JR, Harryman S, et al. Primitive reflex profile: a pilot study. Phys Ther. 1978;58:1061–5 Large-scale study that further established the clinical utility of the primitive reflex profile.

    CAS  PubMed  Google Scholar 

  20. Dos Santos MTBR, Nogueira MLG. Infantile reflexes and their effects on the dental caries and oral hygiene in cerebral palsy individuals. J Oral Rehabil. 2005;32:880–5 Showed that the biting reflex was persistent in children with cerebral palsy and interfered with oral hygiene.

    PubMed  Google Scholar 

  21. Smith SL, Gossman MR, Canan BC. Selected primitive reflexes in children with cerebral palsy: consistency of response. Phys Ther. 1982;62:1115–20 Showed that the extent to which primitive reflexes could be elicited varied in relation to the child’s level of alertness. The results have implications for the timing of conducting reflex assessments.

    CAS  PubMed  Google Scholar 

  22. Zafeiriou DI, Tsikoulas IG, Kremenopoulos GM. Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy. Pediatr Neurol. 1995;13:148–52 Large-scale study showed that retention of primitive reflexes was a useful diagnostic tool for cerebral palsy.

    CAS  PubMed  Google Scholar 

  23. Arthur-Kelly M, Foreman P, Maes B, Colyvas K, Lyons G. Observational data on socio-communicative phenomena in classrooms supporting students with profound intellectual and multiple disability (PIMD): advancing theory development on learning and engagement through data analysis. Adv Neurodev disord. 2018;2:25–37.

    Google Scholar 

  24. Sama AA. Attention-deficit hyperactivity disorder (ADHD) in children: a move towards developmental perspectives. Int J Res Anal Rev. 2020;7:928–38.

    Google Scholar 

  25. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed., DSM-5). Arlington, VA: American Psychiatric Association; 2013.

    Google Scholar 

  26. Taylor M, Houghton S, Chapman E. Primitive reflexes and attention-deficit/hyperactivity disorder: developmental origins of classroom dysfunction. Int J Spec Educ. 2004;19:23–37 Demonstrated that children with ADHD were more likely to retain four types of primitive reflexes compared to typically developing children and that persistence of these reflexes was related to lower academic achievement in the area of mathematics.

    Google Scholar 

  27. Konicarova J, Bob P. Retained primitive reflexes and ADHD in children. Activitas Nervosa Superior. 2012;54:135–8 First in a series of papers by this team showing a high prevalence of persistent primitive reflexes in children with ADHD.

    Google Scholar 

  28. Loyer Carbonneau M, Demers M, Bigras M, Guay M-C. Meta-analysis of sex differences in ADHD symptoms and associated cognitive deficits. J Atten Disord. 2020:108705472092373. https://doi.org/10.1177/1087054720923736.

  29. Konicarova J, Bob P. Asymmetrical tonic neck reflex and symptoms of attention deficit and hyperactivity disorder in children. Int J Neurosci. 2013;123:766–9.

    PubMed  Google Scholar 

  30. Conners CK. Parent symptom questionnaire. Psychopharmacol Bull. 1985;21:816–22.

    Google Scholar 

  31. Konicarova J, Bob P, Raboch J. Persisting primitive reflexes in medication-naïve girls with attention-deficit and hyperactivity disorder. Neuropsychiatr Dis Treat. 2013;9:1457–61.

    PubMed  PubMed Central  Google Scholar 

  32. Melillo R. Primitive reflexes and their relationship to delayed cortical maturation, under connectivity and functional disconnection in childhood neurobehavioral disorders. Funct Neurol Rehabil Ergon. 2011;1:279–314.

    Google Scholar 

  33. Konicarova J, Bob P. Principle of dissolution and primitive reflexes in ADHD. Activitas Nervosa Superior. 2013;55:74–8.

    Google Scholar 

  34. Paulson G, Gottlieb G. Development reflexes: the reappearance of foetal and neonatal reflexes in aged patients. Brain. 1986;92:37–52.

    Google Scholar 

  35. Vreeling FW, Houx PJ, Jolles J, Verhey FRJ. Primitive reflexes in Alzheimer’s disease and vascular dementia. J Geriatr Psychiatry Neurol. 1995;8:111–7.

    CAS  PubMed  Google Scholar 

  36. Hogan DB, Ebly EM. Primitive reflexes and dementia: results from the Canadian study of health and aging. Age Ageing. 1995;24:375–8.

    CAS  PubMed  Google Scholar 

  37. Hodges H, Fealko C, Soares N. Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation. Transl Pediatr. 2020;9(Suppl 1):S55–65.

    PubMed  PubMed Central  Google Scholar 

  38. Damiano CR, Mazefsky CA, White SW, Dichter GS. Future directions for research in autism spectrum disorders. J Clin Child Adolesc Psychol. 2014;43:828–43.

    PubMed  PubMed Central  Google Scholar 

  39. Anderson GM. The potential role for emergence in autism. Autism Res. 2008;1:18–30.

    PubMed  Google Scholar 

  40. Happé F, Firth U. The neuropsychology of autism. Brain. 1996;119:1377–400.

    PubMed  Google Scholar 

  41. Schultz S, Kiln A, Jones W. Neonatal transitions in social behavior and their implications for autism. Trends Cogn Sci. 2018;22:452–69.

    Google Scholar 

  42. Torres EB, Brincker M, Isenhower RW, Yanovich P, Stigler KA, Nurnberger JI, et al. Autism: the micro-movement perspective. Front Integr Neurosci. 2013;7(32):1–26.

    Google Scholar 

  43. Minderaa RB, Volkmar FR, Hansen CR, Harcherik DF, Akkerhuis GW, Cohen DJ. Brief report: Snout and visual rooting reflexes in infantile autism. J Autism Dev Disord. 1985;15:409–16 Classic early study showing extremely high rates of retention of the snout and visual rooting reflexes in children with autism.

    CAS  PubMed  Google Scholar 

  44. de Bildt A, Mulder EJ, Van Lang NDJ, de With SAJ, Minderaa RB, Stahl SS, et al. The visual rooting reflex in individuals with autism spectrum disorders and co-occurring intellectual disability. Autism Res. 2012;5:67–72 Showed a relation between the level of comorbid intellectual disability and likelihood of retaining the visual rooting reflex in a large sample of individuals with autism.

    PubMed  Google Scholar 

  45. Accardo PJ, Barrow W. Toe walking in autism: further observations. J Child Neurol. 2015;30:606–9 The tonic labyrinthine reflex was common and associated with toe walking in a sample of 61 children with autism suggesting that retention of this reflex negatively affected ambulation.

    PubMed  Google Scholar 

  46. Sand T, Mellgren SI, Hestnes A. Primitive reflexes in Down’s syndrome. J Ment Defic Res. 1983;27:39–44 One of the few studies to examine primitive reflexes in adults, specifically adults with Down syndrome. They reported persistence of the palmomental and snout reflex compared to typical controls.

    PubMed  Google Scholar 

  47. Bilbilaj S, Gjipali A, Shkurti F. Measuring primitive reflexes in children with learning disorders. Eur J Multidisciplinary Stud. 2017;2:285–98.

    Google Scholar 

  48. Sohn M, Ahn Y, Lee S. Assessment of primitive reflexes in high-risk newborns. J Clin Med Res. 2011;3:285–90.

    PubMed  PubMed Central  Google Scholar 

  49. Sigafoos J, Roche L, Tait K. Challenges in providing AAC intervention to people with profound intellectual and multiple disabilities. In: Ogletree BT, editor. Augmentative and alternative communication challenges and solutions: improving everyday service delivery (pp: 229–252) Pural Publishing; 2021.

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Acknowledgement

Appreciation is extended to Peter B. Marschik for his helpful comments on previous drafts of this paper.

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Correspondence to Jeff Sigafoos.

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Sigafoos, J., Roche, L., O’Reilly, M.F. et al. Persistence of Primitive Reflexes in Developmental Disorders. Curr Dev Disord Rep 8, 98–105 (2021). https://doi.org/10.1007/s40474-021-00232-2

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